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Saggaf MM, Liu K, Ho G, Anastakis EE, Baltzer H. Sex Difference in the Treatment of Dupuytren's Disease: A Systematic Review and Meta-Analysis of Clinical Trials. Plast Surg (Oakv) 2024; 32:374-383. [PMID: 39104932 PMCID: PMC11298125 DOI: 10.1177/22925503221141707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 08/07/2024] Open
Abstract
Purpose: The aim of this study was to assess the sex differences in enrollment into clinical trials for Dupuytren's disease (DD), treatment efficacy, and complications. Methods: Three databases were searched; Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL. Included studies were clinical trials on adult patients with DD. Exclusion criteria were non-English studies and other study designs. Two independent reviewers completed abstract screening, full-text review, and data extraction. The number and percentage of studies that reported ad hoc analyses for sex differences in treatment efficacy, tolerability, and complications were reported. A meta-analysis was performed on the proportion of female participants enrolled in clinical trials for DD. Results: A total of 3172 references were screened, and 59 studies were identified for full-text review. We identified 28 clinical trials for DD of which none reported secondary analyses for sex differences. Only 2 trials discussed sex differences in complications, and one trial reported sex differences in tolerability. The proportion of female participants in the meta-analysis was 19.5% [95% CI: 16.1-23.0%]. Conclusion: Sex differences in the clinical trials for DD are not widely considered in clinical trials despite their critical role. Males and females do not have equal representation in clinical trials for DD. Future studies should account for sex differences in the design and the analysis of clinical trials.
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Affiliation(s)
- Moaath M. Saggaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kathy Liu
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - George Ho
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Emily E. Anastakis
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Heather Baltzer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Räisänen MP, Leppänen OV, Soikkeli J, Reito A, Malmivaara A, Buchbinder R, Kautiainen H, Kaivorinne A, Stjernberg-Salmela S, Lappalainen M, Luokkala T, Pönkkö A, Taskinen HS, Pääkkönen M, Jaatinen K, Juurakko J, Karjalainen VL, Karjalainen T. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med 2024; 177:280-290. [PMID: 38346307 DOI: 10.7326/m23-1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase. OBJECTIVE To compare the effectiveness of surgery, needle fasciotomy, and collagenase injection at 3 months and 2 years (secondary time points of the trial). DESIGN A multicenter, randomized, outcome assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT03192020). SETTING 6 public hospitals in Finland. PARTICIPANTS 302 persons with treatment-naive Dupuytren contracture (contracture angle <135°). INTERVENTION Surgery (n = 101), needle fasciotomy (n = 101), or collagenase (n = 100). MEASUREMENTS The primary outcome was the success rate, defined as greater than 50% contracture release and patients reaching the patient acceptable symptom state. Secondary outcomes included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events. RESULTS A total of 292 (97%) and 284 (94%) participants completed the 3-month and 2-year follow-ups. Success rates were similar at 3 months: 71% (95% CI, 62% to 80%) for surgery, 73% (CI, 64% to 82%) for needle fasciotomy, and 73% (CI, 64% to 82%) for collagenase. At 2 years, surgery had superior success rates compared with both needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30 [CI, 0.17 to 0.43]) and collagenase (78% vs. 65%; aRD, 0.13 [CI, 0.01 to 0.26]). Secondary analyses paralleled with the primary analysis. LIMITATION Participants were not blinded. CONCLUSION Initial outcomes are similar between the treatments, but at 2 years success rates were maintained in the surgery group but were lower with both needle fasciotomy and collagenase despite retreatments. PRIMARY FUNDING SOURCE Research Council of Finland.
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Affiliation(s)
- Mikko Petteri Räisänen
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.)
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Janne Soikkeli
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Aleksi Reito
- Department of Orthopedics, Tampere University Hospital, Tampere, Finland (A.R.)
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare and Orton Orthopedic Hospital, Helsinki, Finland (A.M.)
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (R.B.)
| | | | - Antti Kaivorinne
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Susanna Stjernberg-Salmela
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland (S.S.)
| | | | - Toni Luokkala
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Annele Pönkkö
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Hanna-Stiina Taskinen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Markus Pääkkönen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Kati Jaatinen
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Joona Juurakko
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | | | - Teemu Karjalainen
- Department of Hand Surgery and Microsurgery, Tampere University Hospital, Tampere, Finland, and Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (T.K.)
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3
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Zhang D, Earp BE, Blazar P. Collagenase Treatment Versus Needle Fasciotomy for Single-Digit Dupuytren Contractures: A Meta-Analysis of Randomized Controlled Trials. J Hand Surg Am 2023; 48:1200-1209. [PMID: 37725027 DOI: 10.1016/j.jhsa.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The objective of this systematic review and meta-analysis was to synthesize the available randomized controlled trial data comparing needle fasciotomy and collagenase treatment for single-digit Dupuytren contractures with a minimum of 3-year follow-up and determine whether one treatment is superior regarding contracture correction and functional outcomes. METHODS A systematic review and meta-analysis was conducted by searching four databases for randomized controlled trials investigating the single-digit treatment outcomes for Dupuytren contracture comparing collagenase treatment and needle fasciotomy with a minimum of 3-year follow-up. The risk of bias of included studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The primary outcome measure was contracture recurrence. Secondary outcome measures included final fixed flexion contracture (FFC), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores, and Unité Rhumatologique des Affections de la Main (URAM) scores. RESULTS After screening 264 articles, 4 randomized clinical trials were eligible for final inclusion. One trial had a high risk of bias, and two trials had some concern for bias. The final meta-analysis included 347 patients, 169 who underwent collagenase treatment and 178 who underwent needle fasciotomy. No significant differences were noted between the groups in contracture recurrence, FFC, and URAM scores. The pooled data showed a higher QuickDASH score in the collagenase treatment group compared with the needle fasciotomy group, but the observed difference was less than what would be expected to be clinically relevant. CONCLUSIONS Needle fasciotomy and collagenase treatment have similar outcomes with regards to contracture recurrence, final FFC, QuickDASH scores, and URAM scores for the single-digit treatment for Dupuytren contracture at a minimum of 3-year follow-up. Relevant factors that may be considered during the shared decision-making process for treatment selection include surgeon and patient preferences, costs of treatment, and the disparate complication profiles of these two treatments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Putnam J. Advanced Dupuytren Contracture: Approach to Management. Hand Clin 2023; 39:455-463. [PMID: 37453772 DOI: 10.1016/j.hcl.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be reduced with a variety of techniques, including skin grafting, external fixator application, radiation, and many others described in this article. Management of recurrence requires special attention to anatomy at risk. Adjuvant therapy may help to prevent the progression or recurrence of severe disease.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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Hozack BA, Rayan GM. Surgical Treatment for Recurrent Dupuytren Disease. Hand (N Y) 2023; 18:641-647. [PMID: 34963318 PMCID: PMC10233643 DOI: 10.1177/15589447211060447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Revision procedures for recurrent Dupuytren disease (DD) can be difficult and carry a high risk of complications. Our goal was to describe surgical strategies used for cases of recurrence and report on their outcomes. METHODS We reviewed 1 surgeon's operative cases for recurrent DD performed at 1 institution. Prior procedures included collagenase injection, percutaneous needle fasciotomy, or open surgical fasciectomy in the same digit or area of the hand. RESULTS From January 1981 to December 2020, 54 procedures were performed on 33 patients for recurrent DD. Most patients were men (82%), had bilateral involvement (64%) and family history (52%), and some had ectopic disease in their feet (24%). The small finger was involved in 76% of the cases, and the proximal interphalangeal (PIP) joint was involved in 83% of these digits. The procedures included 38 partial fasciectomies (72%), 12 dermofasciectomies (23%), 3 radical fasciectomies (6%), 1 of each needle fasciotomy, ray amputation, and PIP joint arthrodesis (2%). Twenty-three patients (43%) required full thickness skin grafts with an average area of 7.1 cm2 (range: 1-20 cm2). CONCLUSIONS This study highlights the complexity of recurrent DD case management and found the treatment required for 95% of patients in this series was open partial fasciectomy with or without demofasciectomy. Full thickness skin grafting was necessary in nearly half of the cases.
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Risk Factors for Long-Term Contracture Recurrence after Collagenase Injection for Dupuytren Disease: A Prospective Cohort Study. Biomedicines 2023; 11:biomedicines11030699. [PMID: 36979678 PMCID: PMC10045631 DOI: 10.3390/biomedicines11030699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
In Dupuytren disease, little is known about the long-term outcomes of collagenase injection or risk factors for contracture recurrence. In this prospective study, 159 patients (242 fingers) with Dupuytren disease and active extension deficit (AED) ≥20° in a metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint were treated with collagenase injection during a 14-month period. At 5 years, 18 patients were deceased, 2 could not be contacted, and 13 had undergone fasciectomy. The remaining 126 patients (199 treated fingers) participated in a follow-up evaluation at 52–96 (mean 65) months after injection, with physical examination (114 patients) or telephone interview (12 patients). Recurrence was defined as subsequent treatment (surgery or repeat injection) or ≥20° AED worsening in a treated joint between the 6-week and 5-year measurements. The mean AED at baseline was 42° (SD 24) for MCP joints and 31° (SD 29) for PIP joints and at 5 years 11° (SD 17) and 17° (SD 23), respectively. Recurrence occurred in 17% of MCP joints and 25% of PIP joints. Statistically significant risk factors for PIP joint contracture recurrence were greater baseline AED (odds ratio 1.04, 95% CI 1.02–1.06) and small finger treatment (OR 4.6, 95% CI 1.5–14.3), with no significant risk factors found for MCP contracture recurrence.
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7
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Three-Year Recurrence of Dupuytren Contracture after Needle Fasciotomy or Collagenase Injection: A Randomized Controlled Trial. Plast Reconstr Surg 2023; 151:365-371. [PMID: 36342689 DOI: 10.1097/prs.0000000000009847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In this randomized controlled trial, the authors compared the recurrence of Dupuytren disease at 3 years following needle fasciotomy or collagenase injection treatment for isolated metacarpophalangeal joint contractures. METHODS The study was conducted between 2013 and 2015. The study design was a single-center, randomized controlled clinical trial with an independent blinded observer. Patients were randomized between collagenase clostridium histolyticum injections (Xiapex) and percutaneous needle fasciotomy (collagenase clostridium histolyticum versus percutaneous needle fasciotomy). A total of 36 patients were followed in the percutaneous needle fasciotomy group and 32 in the collagenase clostridium histolyticum group. RESULTS Patients who were treated with collagenase clostridium histolyticum had a significantly lower recurrence rate than patients treated with percutaneous needle fasciotomy during the 3-year period ( P = 0.007). Of the 36 patients who were followed in the percutaneous needle fasciotomy group, 17 (47%) had recurrence of extension deficit or progression of the disease leading to further treatment. Of the 32 patients who were followed in the collagenase clostridium histolyticum group, six (19%) had recurrence or progression. No serious adverse event was reported in any of the patients. CONCLUSIONS In this randomized controlled trial, we found less recurrence and progression of Dupuytren disease using collagenase injection as compared to percutaneous needle fasciotomy 3 years following treatment for isolated metacarpophalangeal joint contractures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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8
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Discussion: Three-Year Recurrence of Dupuytren Contracture after Needle Fasciotomy or Collagenase Injection: A Randomized Controlled Trial. Plast Reconstr Surg 2023; 151:372-373. [PMID: 36696320 DOI: 10.1097/prs.0000000000009848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Kemler MA, de Wijn RS, van Rijssen AL, van Kooij YE, Ottenhof MP, van Heijl M, Steenbakkers RJ, Geise JB. Dutch Multidisciplinary Guideline on Dupuytren Disease. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:178-183. [PMID: 36974283 PMCID: PMC10039301 DOI: 10.1016/j.jhsg.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/28/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose To provide a comprehensive, evidence-based overview of the treatment for Dupuytren disease, specifically needle techniques, radiotherapy, primary conservative therapy, surgery, lipofilling, operative arthrolysis, salvage techniques, and the postoperative protocol and to make clinical recommendations for health care practitioners and patients. Methods Comprehensive multidisciplinary guideline process funded by the Quality Foundation of the Dutch Federation of Medical Specialists. This process included a development, commentary, and authorization phase. Patients participated in every phase. Multiple databases and existing guidelines up to August 2020 were searched. Studies on Dupuytren disease were considered eligible. Specific eligibility criteria were described per module. To appraise the certainty of the evidence, reviewers extracted data, assessed the risk of bias, and used the Grading of Recommendations Assessment, Development and Evaluation method, where applicable. Important considerations were as follows: patient values and preferences, costs, acceptability of other stakeholders, and feasibility of implementation. Recommendations were made based on the evidence from the literature and the considerations. The primary and secondary outcome measures were defined per module based on the input of patients obtained in collaboration with the Netherlands Patient Federation and health care providers from different professions. Results The following 8 specific modules were completed for Dupuytren disease: (1) needle techniques, (2) radiotherapy, (3) primary conservative therapy, (4) surgery, (5) lipofilling, (6) operative arthrolysis, (7) salvage techniques, and (8) the postoperative protocol. Conclusions Our Dutch multidisciplinary guideline on Dupuytren disease provides 8 modules developed according to the standards of the Dutch Federation of Medical Specialists. Evidence-based recommendations for clinical practice are provided for needle techniques, radiotherapy, primary conservative therapy, surgery, lipofilling, operative arthrolysis, salvage techniques, and the postoperative protocol. This guideline can assist health care providers and patients in clinical practice. Type of study/level of evidence Systematic review/I-II.
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Affiliation(s)
- Marius A. Kemler
- Department of Plastic Surgery, Martini Hospital, Groningen, The Netherlands
- Corresponding author: Marius A. Kemler, MD, PhD, Department of Plastic Surgery, Martini Hospital, PO Box 30033, 9700RM Groningen, The Netherlands.
| | - Robert S. de Wijn
- Department of Plastic Surgery, Red Cross Hospital, Beverwijk and Spaarne Hospital, Haarlem/Hoofddorp, The Netherlands
| | | | - Yara E. van Kooij
- Xpert Handtherapie, Xpert Clinics, Zeist, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mark van Heijl
- Department of Surgery, Hand and Wrist unit, Diakonessenhuis, Utrecht/Zeist/Doorn, The Netherlands
| | | | - Joost B.J. Geise
- Dutch patient association for Dupuytren’s disease, Dronten, The Netherlands
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Żyluk A. Dupuytren's disease - what's new: a review. POLISH JOURNAL OF SURGERY 2022; 95:53-61. [PMID: 38058165 DOI: 10.5604/01.3001.0016.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
<b><br>Introduction:</b> Dupuytren's disease is a common fibrotic disorder of the palmar aponeurosis characterized by the formation of nodules and cords, as well as development of progressive flexion deformities in the digits, leading to functional impairment. Surgical excision of the affected aponeurosis remains the most common treatment. Quite a few new information appeared about epidemiology, pathogenesis and particularly treatment of the disorder.</br> <b><br>Aim:</b> The aim of this study is an updated review of scientific data in this topic.</br> <b><br>Results:</b> Results of epidemiologic studies showed that Dupuytren's disease is not so uncommon in Asian and African population as it was earlier believed. An important role of genetic factors on development of the disease in a proportion of patients was demonstrated, however, it did not translate neither to the treatment nor to the prognosis. The most changes concerned the management of Dupuytren's disease. A positive effect of steroids injections into the nodules and cords for inhibition of the disease in early stages was shown. In the advanced stages, a standard technique of partial fasciectomy was partly replaced by mini-invasive methods such as needle fasciotomy and collagenase Clostirdium hystolyticum injections. Unexpected withdrawal of collagenase from the market in 2020 resulted in considerable limitation of the availability of this treatment.</br> <b><br>Conclusion:</b> It seems that updated knowledge on Dupuytren's disease may be interested and useful for surgeons involved in management of the disorder.</br>.
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Affiliation(s)
- Andrzej Żyluk
- Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, Poland
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11
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Dupuytren Disease: A Retrospective Cohort Study Comparing Collagenase Injection and Percutaneous Needle Fasciotomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4604. [PMID: 36299815 PMCID: PMC9592480 DOI: 10.1097/gox.0000000000004604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
Collagenase Clostridium histolyticum (CCH) injection and percutaneous needle fasciotomy (PNF) are minimally invasive procedures aiming to relieve Dupuytren disease (DD) by disrupting the cord and restoring the normal functionality of the hand. The purpose of this study is to compare the outcomes and recurrence rates for treatment of DD in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints with either collagenase or percutaneous needle at 3-year follow-up. Moreover, we aim to determine the role of these therapeutic modalities and their impact on hand functionality and quality of life. Methods In this retrospective analysis, we compare treatment outcomes in 35 patients, of whom 22 were treated with PNF and 13 with CCH injection. Results The mean outcome in contracture degrees at 3-year follow-up was 9 degrees for MCP joints for both treatment groups, 34 degrees for PNF, and 28 degrees for CCH for PIP joints. There was no statistical significance between the treatment groups in MCP joints (P = 0.786) or in PIP joints (P = 0.474). Contracture recurrences were similar in PIP joints of both groups and greater in MCP joints in the CCH group compared to PNF. The Disabilities of the Arm, Shoulder, and Hand and the Unité Rhumatologique des Affections de la Main scores showed a reduction in impairment in both groups without significant differences between the two groups. Conclusions The results of this study show that PNF appears to be as effective and minimally invasive as CCH injection, but at significantly lower cost. Considering these factors, the authors prefer and recommend the use of PNF over CCH.
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Sandler AB, Scanaliato JP, Dennis T, Gonzalez Trevizo GA, Raiciulescu S, Nesti L, Dunn JC. Treatment of Dupuytren's Contracture With Collagenase: A Systematic Review. Hand (N Y) 2022; 17:815-824. [PMID: 33478271 PMCID: PMC9465774 DOI: 10.1177/1558944720974119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren's disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.
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Affiliation(s)
| | | | | | | | | | - Leon Nesti
- Uniformed Services University of the
Health Sciences, Bethesda, MD, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, El
Paso, TX, USA
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13
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Makuku R, Werthel JD, Zanjani LO, Nabian MH, Tantuoyir MM. New frontiers of tendon augmentation technology in tissue engineering and regenerative medicine: a concise literature review. J Int Med Res 2022; 50:3000605221117212. [PMID: 35983666 PMCID: PMC9393707 DOI: 10.1177/03000605221117212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tissue banking programs fail to meet the demand for human organs and tissues for
transplantation into patients with congenital defects, injuries, chronic
diseases, and end-stage organ failure. Tendons and ligaments are among the most
frequently ruptured and/or worn-out body tissues owing to their frequent use,
especially in athletes and the elderly population. Surgical repair has remained
the mainstay management approach, regardless of scarring and adhesion formation
during healing, which then compromises the gliding motion of the joint and
reduces the quality of life for patients. Tissue engineering and regenerative
medicine approaches, such as tendon augmentation, are promising as they may
provide superior outcomes by inducing host-tissue ingrowth and tendon
regeneration during degradation, thereby decreasing failure rates and morbidity.
However, to date, tendon tissue engineering and regeneration research has been
limited and lacks the much-needed human clinical evidence to translate most
laboratory augmentation approaches to therapeutics. This narrative review
summarizes the current treatment options for various tendon pathologies, future
of tendon augmentation, cell therapy, gene therapy, 3D/4D bioprinting,
scaffolding, and cell signals.
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Affiliation(s)
- Rangarirai Makuku
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-David Werthel
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Oryadi Zanjani
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Marcarious M Tantuoyir
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France.,Biomedical Engineering Unit, University of Ghana Medical Centre, Accra, Ghana
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The Effect of Anticoagulation on the Treatment of Dupuytren Contracture with Collagenase. Plast Reconstr Surg 2022; 149:914e-920e. [PMID: 35271531 DOI: 10.1097/prs.0000000000009038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There have been no formal studies of the use of collagenase clostridium histolyticum (Xiaflex; Endo Pharmaceuticals, Malvern, Pa.) in the anticoagulated patient. Previous study on its use excluded patients receiving anticoagulation therapy. This study reviewed the effects of anticoagulation use in patients undergoing collagenase clostridium histolyticum injection and cord rupture to determine safety and efficacy. METHODS The authors retrospectively reviewed patients receiving collagenase clostridium histolyticum injections for Dupuytren contracture between 2010 and 2017. Outcomes included type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding. RESULTS A total of 388 injections were performed in 197 patients. The average clinical follow-up was 311 days. Fifty-two percent of patients (n = 201) were anticoagulated. The vast majority were taking aspirin (acetylsalicylic acid) (n = 182), followed by warfarin (n = 27), clopidogrel (n = 9), apixaban (n = 8), rivaroxaban (n = 4), and dabigatran (n = 2). There were 42 skin tears, 21 in the anticoagulated group. One tendon rupture occurred in the anticoagulated group (acetylsalicylic acid) and none occurred in the nonanticoagulated group (p = 0.34). No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding. CONCLUSIONS Anticoagulation is commonly encountered by hand surgeons treating Dupuytren contracture. There is no significant difference in complications in the anticoagulated patient versus the nonanticoagulated patient. It is safe to perform collagenase clostridium histolyticum injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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15
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Byström M, Ibsen Sörensen A, Samuelsson K, Fridén JO, Strömberg J. Five-Year Results of a Randomized, Controlled Trial of Collagenase Treatment Compared With Needle Fasciotomy for Dupuytren Contracture. J Hand Surg Am 2022; 47:211-217. [PMID: 35074248 DOI: 10.1016/j.jhsa.2021.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 09/16/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Over the past decade, collagenase treatment and needle fasciotomy (NF) have gained widespread popularity in the treatment of Dupuytren contracture. This prospective study was designed to compare the results of these treatments in terms of clinical and patient-reported outcomes. METHODS A prospective, randomized, controlled trial included patients with a contracture of 20° or more in a single metacarpophalangeal joint. Patients were allocated to treatment with either NF or collagenase Clostridium histolyticum. The primary outcome was a reduction in the metacarpophalangeal joint contracture to less than 5°. Secondary outcomes included recurrence, the presence of Dupuytren cords, and changes in patient-reported outcomes. The participants were examined 5 years after the intervention. RESULTS The study cohort comprised 156 patients divided into 2 equally sized groups. After 5 years, data were collected from 143 (92 %) of the initially enrolled participants. The mean time for the clinical follow-up was 5.1 years. In the remaining cohort without a second procedure, 51% (23 patients) in the collagenase Clostridium histolyticum group and 47% (27 patients) in the NF group still had extension deficits of less than 5°. Among the participants with a successful initial procedure, the recurrence rate was 56% (36 patients) in the collagenase Clostridium histolyticum group and 45% (30 patients) in the NF group. There were no differences between the 2 treatments in regard to passive joint extension, reduction of contracture, range of motion, or patient-reported outcomes. CONCLUSIONS The 5-year outcomes for NF are similar to those for collagenase in terms of sustained correction, recurrence, presence of Dupuytren cords, and patient-reported outcomes for the treatment of metacarpophalangeal joint contractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Martin Byström
- Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Jan O Fridén
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Joakim Strömberg
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery and Orthopaedics, Alingsås Hospital, Alingsås, Sweden
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16
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Treatment Options for Dupuytren’s Disease: Tips and Tricks. PLASTIC AND RECONSTRUCTIVE SURGERY - GLOBAL OPEN 2022; 10:e4046. [PMID: 35186619 PMCID: PMC8849405 DOI: 10.1097/gox.0000000000004046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
Dupuytren's disease (DD) is a common fibroproliferative condition of the hand.
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17
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Johnson N, Kurien T, Selby A, O'Brien M. Improvement in the Appearance and Function of the Hand at 2 Weeks after Percutaneous Needle Fasciotomy for Dupuytren Disease. J Hand Surg Asian Pac Vol 2022; 27:62-67. [PMID: 35037575 DOI: 10.1142/s2424835522500059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Percutaneous needle fasciotomy (PNF) has been successfully used for the treatment of contracture bands in the hand in patients with Dupuytren disease. The aim of this study is to determine aesthetic and functional outcomes at 2 weeks following PNF in patients with Dupuytren contracture. Methods: Seventy-five patients undergoing PNF for Dupuytren disease during a 4-month period were included. Patients completed the Visual Analogue Appearance Score (VAAS), Derriford Appearance Score (DAS), and the quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH) preoperatively and at 2 weeks after surgery. In addition, VAAS was done in the immediate postoperative period as well. Results: Seventy-four (99%) patients completed the immediate postoperative VAAS scores and 51 (68%) completed the VAAS, DAS, and QuickDASH at 2 weeks. Preoperative VAAS fell from 6.01 to 1.53 (p < 0.0001) immediately post operation. Two weeks later, VAAS increased to 2.91 but was still significantly lower than preoperatively (p < 0.0001). DAS was unchanged. QuickDASH decreased from 22.4 preoperatively to 12.1 2 weeks later (p = 0.001). Conclusion: PNF for Dupuytren contracture resulted in improvement in both aesthetic and functional outcomes at 2 weeks. Longer term follow-up is required to determine whether these improvements are sustained. Level of Evidence: Level IV (Therapeutic).
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18
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Warwick D, NM Werker P, Pess G, Hirata H, Hunter-Smith DJ. Dupuytren's disease: using needles more across the world. J Hand Surg Eur Vol 2022; 47:80-88. [PMID: 34496664 PMCID: PMC8721555 DOI: 10.1177/17531934211043307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 02/03/2023]
Abstract
In this article we take an international perspective on the use of needles, either percutaneous needle fasciotomy (PNF) or Clostridial Collagenase Histiolyticum (CCH), in treating Dupuytren's Disease (DD). Worldwide, PNF is now used more frequently. The CCH has been withdrawn from non-USA markets, which lessens its use. Different patients have different preferences, while different surgeons have different skills and opinions. The surgeon should fully consider the patient's preference and should also, in view of the scarcity of surgical resource and the potential hazard of surgery, reconsider and expand the use of a needle rather than an operation. In the future, a cheaper, yet equally safe and effective alternative to CCH, will provide a useful clinical tool for those cords, which, in the surgeon's personal Venn diagram, are too challenging for PNF, but the patient does not want to have surgery.
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Affiliation(s)
| | - Paul NM Werker
- Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Gary Pess
- Central Jersey Hand Surgery, Eatontown, NJ, USA
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School & Faculty of Medicine Nagoya University, Nagoya, Japan
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Clinical School at Monash University, Melbourne, Australia
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19
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Sanjuan-Cervero R, Gomez-Herrero D, Vazquez-Ferreiro P, Sanjuan-Arago A, Poquet-Jornet JE, Carrer-Hueso J. Sensitivity and Specificity of the Unité Rhumatologique Des Affections De La Main (URAM) Scale for Dupuytren Contracture: A Systematic Review and Meta-Analyses. Cureus 2022; 14:e21636. [PMID: 35233314 PMCID: PMC8881277 DOI: 10.7759/cureus.21636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Unité Rhumatologique des Affections de la Main (URAM) is a novel and disease-specific questionnaire for Dupuytren contracture, a fibroproliferative disease that affects hands causing progressive contracture in flexion of the fingers. OBJECTIVES To evaluate the sensitivity and specificity of the URAM scale in Dupuytren contracture. MATERIALS AND METHODS We performed meta-analyses of 10 articles published in PubMed, Embase, Cochrane, Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), and in various grey literature databases that describe the use of the URAM and Tubiana scales to assess treatment outcomes in Dupuytren contracture. We built three models: a hierarchical summary receiver operating characteristic (HSROC) model to determine the optimal threshold for defining Dupuytren contracture, a difference in means model to assess the magnitude of the effect of different treatment modalities, and a meta-regression model to determine the effect on patient quality of life questionnaires such as the URAM, according to variations in Tubiana scores after treatment. RESULTS The HSROC and bivariate models showed a sensitivity of 80.23% (95% CI: 75.66 to 84.14) and an overall specificity of 2.61% (95% CI: 1.11 to 6.05). The second model showed an overall difference in means of 1.95 (95% CI: -2.86 to -1.04) for partial fasciectomy and collagenase Clostridium histolyticum (CCH) injections, and -1.30 (95% CI: -1.77 to -0.83) for partial fasciectomy, and -2.75 (95% CI: -4.73 to -0.78) for CCH. The coefficient obtained in the meta-regression model was -1.666 (95% CI: -4.183 to 0.851). CONCLUSION The URAM scale is highly sensitive to changes in Dupuytren contracture but has low specificity. It also showed a strong correlation with worsening of finger contracture as measured by the Tubiana scale.
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20
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Ruettermann M, Hermann RM, Khatib-Chahidi K, Werker PMN. Dupuytren's Disease–Etiology and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:781-788. [PMID: 34702442 DOI: 10.3238/arztebl.m2021.0325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and Embase. RESULTS Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence. CONCLUSION Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.
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21
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Ahmad F, Raizman N, Giladi AM, Akoon A, Wongworawat MD, Wysocki RW. Report on the Evidence-Based Practice Committee’s Survey on Dupuytren Disease. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:317-321. [PMID: 35415589 PMCID: PMC8991593 DOI: 10.1016/j.jhsg.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The Evidence-Based Practice Committee of the American Society for Surgery of the Hand (ASSH) set out to assess the membership’s practice patterns (PPs) and knowledge of evidence-based principles for Dupuytren disease (DD). Methods A 21-item multiple-choice survey was distributed to all ASSH members via email in June 2020. Questions were divided into 2 types: evidence-based practice (EBP) and PPs. The survey addressed the following subtopics: nonsurgical, percutaneous, and open surgical management of DD. Results The response rate was 18% (n = 419). Of 13 EBP questions, 5 were answered with the preferred response by >75% of surgeons. The remaining 8 EBP questions had greater frequencies of less preferred responses, which concerned the current evidence for percutaneous management, as well as nonsurgical and postoperative management of DD. Of the PP questions, there were differences in opinion on how to manage a painful nodule, the percutaneous technique (eg, collagenase injection vs percutaneous needle aponeurotomy), and the choice of surgical incision for open fasciectomy (eg, Bruner incision with Z-plasties, partial closure with an open transverse palmar component, or longitudinal incision with Z-plasties). Conclusions Hand surgeons continue to be well informed about current evidence-based practices for treating DD and can improve their knowledge by familiarizing themselves with current data on percutaneous and nonsurgical methods. There exist differences in PPs for DD in the ASSH membership, specifically with less invasive management; and knowledge of peer practices can help navigate differences, critically interpret the evidence, and optimize patient care. Type of study/level of evidence Economic/Decision Analyses V.
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22
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Zhang D, Blazar P, Benavent KA, Earp BE. Long-term Effects of Skin Tearing on Outcomes After Collagenase Treatment of Dupuytren Contractures. Hand (N Y) 2021; 16:792-796. [PMID: 31941375 PMCID: PMC8647323 DOI: 10.1177/1558944719898836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to compare the rates of recurrence, additional treatment, patient satisfaction, and willingness to undergo Clostridium histolyticum (CCH) treatment again for Dupuytren disease in patients with and without skin tearing at minimum 5-year follow-up. Methods: We identified 199 digits in 142 patients who underwent CCH treatments for Dupuytren disease from April 2010 to December 2013 with minimum 5-year follow-up. Patients were contacted by telephone to collect our response variables: perceived recurrence of contracture, additional treatment, satisfaction, and willingness to undergo CCH treatment again. Medical records were reviewed for skin tearing at manipulation and patient-related and disease-specific variables. Results: At the time of manipulation, 16 out of 142 patients (11%) and 22 out of 199 digits (11%) had skin tearing. Older age was associated with skin tearing. At an average 7.2-year follow-up, the mean satisfaction was 7.1 ± 2.6 on a 1 to 10 Likert scale for patients with skin tearing and 6.5 ± 3.4 for patients without skin tearing. Eighty-one percent of patients with skin tearing expressed willingness to undergo CCH treatment again, compared with 68% of patients without skin tearing. Perceived recurrence of contracture occurred in 82% of digits with skin tearing and 80% of digits without skin tearing. Additional treatment was performed in 45% of digits with skin tearing and 54% of digits without skin tearing. No difference was statistically significant. Conclusions: Although skin tearing at CCH manipulation complicates the short-term course following CCH treatment, it does not affect long-term perceived contracture recurrence or patient satisfaction.
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Affiliation(s)
- Dafang Zhang
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Dafang Zhang, Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Philip Blazar
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Brandon E. Earp
- Brigham and Women’s Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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23
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Göransson I, Brudin L, Irbe A, Turesson C. Hand function 5 years after treatment with collagenase Clostridium histolyticum injection for Dupuytren's disease. J Hand Surg Eur Vol 2021; 46:985-994. [PMID: 33757325 DOI: 10.1177/17531934211002383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to report hand function, disability and satisfaction and patients' perception of functionally troublesome contractures 5 years after injection with collagenase Clostridium histolyticum and hand therapy for Dupuytren's disease. Data from 79 patients were collected before and at 3, 12 and 60 months after treatment. Hand function was significantly improved, and 70% achieved a functional range of motion in the treated hand. QuickDASH scores and range of motion were best at 3 months follow-up. At 60 months, mean total extension deficit was 48°, which was 57% of the deficit before treatment. Thirty-seven patients (47%) had developed recurrent contractures in treated finger(s) meeting the criteria for new treatment. The threshold for functionally troublesome contractures was found to be 30°-60° in the finger joints. Treatment was experienced as painful, but few hand function problems occurred. Most patients would choose this treatment method again.Level of evidence: IV.
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Affiliation(s)
- Ingrid Göransson
- Department of Occupational Therapy and Physiotherapy, Kalmar County Hospital, Kalmar, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Regional Council in Kalmar County, Kalmar, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Andra Irbe
- Orthopaedic Clinic, Kalmar County Hospital, Kalmar, Sweden
| | - Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Lanfranchi E, Fairplay T, Arcuri P, Lando M, Marinelli F, Pillastrini P, Vanti C. The Italian version of the Unité Rhumatologique des Affections de la Main (URAM) for Dupuytren's disease: The URAM-I(10). HAND THERAPY 2021; 26:91-101. [PMID: 37904881 PMCID: PMC10584047 DOI: 10.1177/17589983211034532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2023]
Abstract
Introduction Several general hand functional assessment tools for Dupuytren's disease have been reported, but none of the patient-reported-outcome measures specific to Dupuytren's disease-associated disabilities are available in the Italian language. The purpose of this study was to culturally adapt the Unité Rhumatologique des Affections de la Main (URAM) into Italian (URAM-I) and determine its measurement properties. Methods Cross-cultural adaptation was performed according to the current guidelines. Construct validity (convergent and divergent validity) was measured by comparing the URAM-I with the Pain-Rated Wrist/Hand Evaluation (PRWHE-I), Short-Form 36 (SF-36-I) scale and finger range of motion, respectively. Factor analysis was used to investigate the URAM-I's internal structure. Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability by Intra-Class Correlation Coefficient (ICC). Results This study included 96 patients (males = 85%, age = 66.8 ± 9.3). Due to the cultural adaptation, we divided the original item #1 into two separate items, thus generating the URAM-I(10). Convergent validity analysis showed a strong positive (r = 0.67), significant (p < 0.01) Pearson's correlation with the PRWHE-I. Divergent validity analysis showed a weak, negative (r < 0.3) and not significant correlation with the SF-36-I subscales, except for the physical pain subscale (r = -0.21, p < 0.05). Factor analysis revealed a 2-factor, 4-item solution that explained 76% of the total variance. The URAM-I(10) demonstrated high internal consistency (α = 0.94) and high test-retest reliability (ICC = 0.97). Conclusion The URAM-I(10) demonstrates moderate construct validity, high internal consistency and test-retest reliability, and showed a 2-factor internal structure. Its evaluative use can be suggested for the Italian Dupuytren's population.
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Affiliation(s)
- E Lanfranchi
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - T Fairplay
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Hand Surgery and Hand Rehabilitation, Modena Polyclinic Hospital, Modena, Italy
| | - P Arcuri
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Lando
- Department of Hand Surgery and Hand Rehabilitation, Modena Polyclinic Hospital, Modena, Italy
| | - F Marinelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - P Pillastrini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - C Vanti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Hirase T, Suresh R, Cotton MO, Han A, Burn MB, Harris JD, Liberman SR. Percutaneous Needle Fasciotomy versus Collagenase Injection for Dupuytren's Contracture: A Systematic Review of Comparative Studies. J Hand Microsurg 2021; 13:150-156. [PMID: 34511831 PMCID: PMC8426042 DOI: 10.1055/s-0040-1721876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The purpose of this study was to review and compare clinical outcomes between percutaneous needle fasciotomy (PNF) and collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren's contracture. Materials and Methods A systematic review was performed including all level I-III evidence studies investigating the clinical outcomes of PNF and CCH injection in the treatment of Dupuytren's contracture. Results Five studies (278 CCH patients, 225 PNF patients; 285 CCH fingers, 246 PNF fingers, 405 males, and 98 females) were analyzed. Two randomized studies were level I evidence, one randomized study was level II, and two nonrandomized studies were level III. Two studies analyzed a total of 205 patients, each demonstrating statistically superior outcomes in one outcome measure (contracture improvement and Michigan Hand Questionnaire (MHQ) satisfaction subscore) with PNF, while the remaining three studies demonstrated no significant differences in outcomes between the two techniques. Three studies reported a statistically higher rate of minor complications (local pain, edema, ecchymosis, lymphadenopathy, pruritis) with CCH, while the remaining two studies demonstrated no significant difference in complication rates. Conclusion For the treatment of Dupuytren's contracture, there is some evidence that suggests superior clinical outcomes of PNF compared with CCH and a higher minor complication rate with CCH.
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Affiliation(s)
- Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Rishi Suresh
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Michael O. Cotton
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Alex Han
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Matthew B. Burn
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Joshua D. Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
| | - Shari R. Liberman
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, United States
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Current Concepts in the Management of Dupuytren Disease of the Hand. J Am Acad Orthop Surg 2021; 29:462-469. [PMID: 33651754 DOI: 10.5435/jaaos-d-20-00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 02/01/2023] Open
Abstract
Dupuytren disease is a fibroproliferative disorder of the palmar fascia of the hand. Little agreement and remarkable variability exists in treatment algorithms between surgeons. Because the cellular and molecular etiology of Dupuytren has been elucidated, ongoing efforts have been made to identify potential chemotherapeutic targets that could modulate the phenotypic expression of the disease. Although these efforts may dramatically alter the approach to treating this disease in the future, these approaches are largely experimental at this point. Over the past decade, the mainstay nonsurgical options have continued to be percutaneous needle aponeurotomy and collagenase Clostridium hystoliticum, and the most common surgical option is limited fasciectomy.
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27
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Gómez-Herrero D, Carrera-Hueso FJ, Sanjuan-Cerveró R, Montaner-Alonso D, Aguilella-Fernandez L, Vazquez-Ferreiro P, Poquet-Jornet JE, García-Jiménez E. "Validation of a spanish version of the 'Unité Rhumatologique Des Affections De La Main' (URAM) scale". J Plast Reconstr Aesthet Surg 2020; 74:1621-1628. [PMID: 33371958 DOI: 10.1016/j.bjps.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 10/06/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In health care, quality-of-life surveys and questionnaires related to care are becoming increasingly important as a measure of its quality. There is currently no Spanish version of the Unité Rhumatologique des Affections de la Main (URAM) scale, which makes it suitable for hand pathology. The purposes of this study are to develop a Spanish version of the URAM and perform a transcultural adaptation of it, analyzing the result for reliability, validity, and sensitivity to changes. METHODS The questionnaire was evaluated for patients with Dupuytren's disease and Carpal Tunnel Syndrome. The cohort study subjects were interviewed at three points in time (baseline, three days after intervention, and one month after), administering the QuickDASH, URAM, and SF-12 (CF12 = physical component, CM12 = mental component) questionnaires at baseline and after intervention; and only the URAM at 3 days. Content validity was evaluated using Cronbach's α. The distribution of the factorial loads of the items and the pattern of the answers were checked. Responsiveness was evaluated by the size of the effect and the reliable rate of change. Convergent and divergent validity was performed using Spearman's r between the different questionnaires. RESULTS The study was conducted with 106 patients. The mean baseline scores were: URAM = 14.8, QuickDASH = 41.6, CF12 = 39.3 and CM12 = 49.4. Ceiling or floor effects were not observed in the Spanish URAM. The Cronbach α = 0.853 explains 49.6% of the variance. The study had a high reproducibility (intraclass correlation coefficient (ICC) = 0.939). Size effect, measured as differences in scores, was moderate for URAM (-0.69) and QuickDASH (-0.51); and low for CF12 and CM12. The correlation of URAM with QuickDASH was high (r = 0.716), and moderate with DD and CTS. CONCLUSION The Spanish version of the URAM is a valid and reliable tool for use in assessing hand pathology.
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Affiliation(s)
- Diego Gómez-Herrero
- Pharmacy Department. Vithas Hospital 9 de Octubre. Valle de la Ballestera, 59. 46015, Valencia. Spain; Pharmacy Program. University of Granada. Faculty of Pharmacy. 18011, Granada. Spain.
| | - Francisco J Carrera-Hueso
- Pharmacy Department. Hospital Universitario La Plana. Ctra. Vila Real-Burriana Km 0.5. 12540, Vila-Real, Castellón. Spain
| | - Rafael Sanjuan-Cerveró
- Orthopedics and Traumatology Surgery Department. Hospital de Denia. Marina Alta s/n. 03700, Denia, Alicante. Spain
| | - Daniel Montaner-Alonso
- Orthopedics and Traumatology Surgery Department. Hospital Doctor Peset. Gaspar Aguilar, 90. 46017, Valencia. Spain
| | - Luis Aguilella-Fernandez
- Orthopedics and Traumatology Surgery Department. Hospital de la Ribera. Ctra. Corbera Km 1. 46600, Alzira, Valencia. Spain
| | - Pedro Vazquez-Ferreiro
- Ophtalmologic Department. Hospital Virxe da Xunqueira. Paseo do Alcalde Pepe Sánchez, 7. 15270, Cee, A Coruña. Spain
| | - Jaime E Poquet-Jornet
- Pharmacy Department. Hospital de Denia. Marina Alta s/n. 03700,Denia, Alicante. Spain
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Hensler S, Wehrli M, Herren D, Marks M. Measurement properties of the German Unité Rhumatologique des Affections de la Main (URAM) scale in patients treated for Dupuytren's disease. HAND SURGERY & REHABILITATION 2020; 39:568-574. [DOI: 10.1016/j.hansur.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
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Discussion: Collagenase Treatment of Dupuytren’s Disease with Minimum 5-Year Follow-Up: Recurrence, Reintervention, and Satisfaction. Plast Reconstr Surg 2020; 146:1080-1081. [DOI: 10.1097/prs.0000000000007316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
IMPORTANCE Owing to its tendency to recur, Dupuytren contracture often requires multiple treatments, which places additional economic burden on health care. The likelihood of contracture recurrence varies not only with treatment but also with disease characteristics, such as contracture severity and location, but prior cost-effectiveness analyses of Dupuytren contracture treatments have not considered these patient-specific disease characteristics. OBJECTIVE To identify the most cost-effective treatment regimen for patients with recurrent Dupuytren contracture. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted with state-transition microsimulation modeling using data from published studies and Medicare. A simulated cohort of 10 000 individuals with Dupuytren contracture was created. Patients could transition yearly between the following health states: symptom-free, symptomatic, and death. Available treatments were collagenase clostridium histolyticum injection, percutaneous needle aponeurotomy (PNA), and limited fasciectomy (LF); individuals randomly chose any treatment when symptomatic. Patients were limited to 3 rounds of treatment for a contracture affecting 1 joint, totaling 27 unique combinations. If the contracture recurred after 3 treatments, patients lived with the disease for the remainder of life. EXPOSURES PNA, collagenase clostridium histolyticum injection, or LF. MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs), total costs (in US dollars), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per quality-adjusted life-year was used to assess cost-effectiveness. RESULTS For the base case scenario of a patient aged 60 years with recurrent, low-severity metacarpophalangeal (MCP) joint contracture, repeated PNA treatment was the only cost-effective treatment (2 PNA treatments followed by LF vs 3 PNA treatments, ICER [Monte Carlo SE]: $212 647/QALY [$36 000/QALY]). For recurrent high-severity MCP joint contractures, treatment regimens composed of PNA and LF were cost-effective (ICER [Monte Carlo SE], $93 932/QALY [$16 500/QALY]). LF was cost-effective for high-severity MCP joint contracture (ICER [Monte Carlo SE], $98 624/QALY [$26 233/QALY]). For recurrent proximal interphalangeal (PIP) joint contractures, PNA was the only cost-effective treatment, regardless of severity (eg, 2 PNA treatments followed by LF vs 3 PNA treatments for low-severity PIP joint contracture, ICER [Monte Carlo SE]: $263 726/QALY [$29 000/QALY]). Any combination with collagenase clostridium histolyticum injection compared with 3 PNA treatments had an ICER greater than $100 000 per QALY. Probabilistic sensitivity analysis estimated a 44%, 15%, 41%, and 52% chance of a regimen consisting of only PNA being cost-effective in low-severity MCP, high-severity MCP, low-severity PIP, and high-severity PIP joint contractures, respectively. CONCLUSIONS AND RELEVANCE The results of this study suggest that LF is a cost-effective intervention for recurrent high-severity MCP joint contractures. For recurrent low-severity MCP joint contractures and PIP joint contractures of all severity levels, PNA was the only cost-effective intervention. Collagenase clostridium histolyticum injections were not a cost-effective intervention for recurrent Dupuytren contracture and should not be preferred over PNA or LF.
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Affiliation(s)
- Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Robert L. Kane
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - David W. Hutton
- Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Chambers J, Pate T, Calandruccio J. Office-Based Percutaneous Fasciotomy for Dupuytren Contracture. Orthop Clin North Am 2020; 51:369-372. [PMID: 32498955 DOI: 10.1016/j.ocl.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Percutaneous fasciotomy is a safe, simple, and inexpensive treatment for mild to moderate Dupuytren contracture. The decrease in extension deficit in the metacarpophalangeal and proximal interphalangeal joints after release correlates with improvement in patient-reported outcomes. Complications are rare and primarily include skin tears, which occur in approximately 4% of patients. Most patients are satisfied with the outcomes of the procedure at 1 year.
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Affiliation(s)
- James Chambers
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Taylor Pate
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James Calandruccio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
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Percutaneous needle fasciotomy in Dupuytren contracture: a register-based, observational cohort study on complications in 3,331 treated fingers in 2,257 patients. Acta Orthop 2020; 91:326-330. [PMID: 32056475 PMCID: PMC8023958 DOI: 10.1080/17453674.2020.1726057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Percutaneous needle fasciotomy (PNF) is a minimally invasive treatment option for Dupuytren contracture, which has gained momentum worldwide in recent years. However, evidence regarding safety and severe complications associated with PNF is sparse. Thus, we evaluated safety of a specific PNF method in the largest cohort reported in literature.Patients and methods - This is a single-center, register-based, observational study on PNF treatments between 2007 and 2015. The study cohort was identified by the Danish National Patient Registry, and diagnosis codes and procedure codes were used to identify potential severe postoperative complications such as: tendon rupture, nerve damage, infection, amputation, and reflex dystrophy for all index treatments. The Danish National Prescription Registry was used to identify non-hospital-treated infections. All index treatments and postoperative complications were verified by review of medical records.Results - 2,257 patients received PNF treatment of 3,331 treated finger rays. Median follow-up was 7.2 years (interquartile range: 4.9-9.5 years, range 1-12 years). 4 patients sustained flexor tendon rupture. 1 patient had digital nerve damage. 2 patients had an infection treated in hospital, while 31 patients received antibiotics in the primary sector for an infection or based on suspicion of an infection after PNF. None of the infections required surgical intervention. No finger amputations or ipsilateral upper limb reflex dystrophy cases were registered in relation to the procedure.Interpretation - Percutaneous needle fasciotomy for Dupuytren contracture is a safe procedure with a low rate of severe postoperative complications when a specific PNF method is applied.
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Comparison of Treatment Outcomes after Collagenase Injection and Percutaneous Needle Fasciotomy for Dupuytren's Contracture: Objective and Subjective Comparisons with a 3-Year Follow-Up. Plast Reconstr Surg 2020; 145:1464-1474. [PMID: 32459776 DOI: 10.1097/prs.0000000000006828] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study compared the effectiveness of injectable collagenase clostridium histolyticum and percutaneous needle fasciotomy in the treatment of Dupuytren's contracture. METHODS Patients with a total passive extension deficit of 30 degrees or more in a single digital ray were enrolled and assigned randomly to receive either collagenase clostridium histolyticum injections or percutaneous needle fasciotomy. Preoperative severity of proximal interphalangeal joint contracture for Dupuytren's disease was classified according to the British Society for Surgery of the Hand as less than 30 degrees (stage I) or 30 degrees or more (stage II). RESULTS Of the 70 patients enrolled, 36 patients with 46 joints received collagenase clostridium histolyticum injections and 34 patients with 48 joints received percutaneous needle fasciotomy. At day 30, successful corrections were obtained in only 50 percent of the injection group and 67 percent of the fasciotomy group for stage II proximal interphalangeal joints. Recurrences were frequent among patients with stage II joint contractures. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score at day 30 was significantly higher in the injection group compared with the fasciotomy group (7.5 versus 4.2, respectively). In the injection group, adverse events were reported for all patients. In the fasciotomy group, complications were reported for 15 percent of patients. CONCLUSIONS The collagenase clostridium histolyticum and percutaneous needle fasciotomy groups had similar outcomes for Dupuytren's contracture with 3 years' follow-up. Recurrences were frequent among patients with stage II proximal interphalangeal joint contractures. The Unité Rhumatologique des Affections de la Main scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire score decreased significantly for both groups at final follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Huynh KA, Chung KC. Using Evidence for Hand Surgery: How to Practice Evidence-Based Hand Surgery Care. Hand Clin 2020; 36:137-144. [PMID: 32307043 DOI: 10.1016/j.hcl.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Each step of the evidence-based practice process is critical and requires clear understanding for accurate application. To practice evidence-based care, providers must acquire a specific skillset that facilitates translation of a patient problem into an answerable research question. Additional requirements are understanding of electronic databases, critical appraisal of the available evidence, and integration of the findings to generate a specific, individualized treatment plan. Although this process is demanding, evidence-based practice is essential in the delivery of optimal patient care.
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Affiliation(s)
- Kristine A Huynh
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Michigan Medicine Comprehensive Hand Center, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren's Contracture: A Retrospective Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2606. [PMID: 32095410 PMCID: PMC7015605 DOI: 10.1097/gox.0000000000002606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
Dupuytren's contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences. Methods We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more). Results The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02). Conclusion Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren's contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.
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Zhang D, Earp BE, Blazar P. Risk Factors for Skin Tearing in Collagenase Treatment of Dupuytren Contractures. J Hand Surg Am 2019; 44:1021-1025. [PMID: 31420243 DOI: 10.1016/j.jhsa.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/11/2019] [Accepted: 06/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine factors associated with skin tearing at the time of manipulation in patients undergoing collagenase Clostridium histolyticum (CCH) treatment for Dupuytren contractures. METHODS We identified 368 digits in 261 patients who underwent a total of 469 CCH treatments at a tertiary care referral center from April, 2010 to December, 2013. Medical records were reviewed for the primary outcome, skin tearing at manipulation. Patient-related and disease-specific explanatory variables were collected. We used bivariate analysis to screen for risk factors and multivariable logistic regression to determine associated risk factors for skin tearing. RESULTS The overall rate of skin tearing with CCH treatment was 12%. Multivariable logistic regression analysis showed older age (odds ratio = 1.04; 95% confidence interval, 1.00-1.07) and amount of contracture correction (odds ratio = 1.02; 95% confidence interval, 1.01-1.04) to be associated with skin tearing at manipulation. CONCLUSIONS A 10-year increase in age results in a 1.5 times increase in the odds of skin tearing. A 30° increase in contracture correction results in a 1.8 times increase in the odds of skin tearing. Patients can be counseled before CCH treatment that older age and increased contracture correction are risk factors for this common complication. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Nordenskjöld J, Lauritzson A, Åkesson A, Atroshi I. Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands. Acta Orthop 2019; 90:517-522. [PMID: 31500473 PMCID: PMC6844429 DOI: 10.1080/17453674.2019.1663472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Few prospective studies have reported the long-term effect durability of collagenase injections for Dupuytren disease. We assessed the 3-year treatment outcome of collagenase injections and predictors of recurrence.Patients and methods - We conducted a single-center prospective cohort study. Indication for collagenase injection was palpable Dupuytren's cord and active extension deficit (AED) ≥ 20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. From November 2012 through June 2013, we treated 86 consecutive patients (92 hands, 126 fingers). A hand therapist measured joint contracture before, 5 weeks, and 3 years after injection. The patients rated their treatment satisfaction. Primary outcome was proportion of treated joints with ≥ 20° AED worsening between the 5-week and 3-year measurements. We analyzed predictors of recurrence.Results - 3-year outcomes were available for 83 of the 86 patients (89 hands, 120 treated fingers). Between the 5-week and 3-year measurements, AED worsened by ≥ 20° in 17 MCP (14%) and 28 PIP (23%) joints. At 3 years, complete correction (passive extension deficit 0-5°) was present in 73% of MCP and 35% of PIP joints. Treatment of small finger PIP joint contracture, greater pretreatment contracture severity, and previous fasciectomy on the treated finger were statistically significant predictors of recurrence. Treatment satisfaction was rated as very satisfied or satisfied in 59 of 87 hands. No long-term treatment-related adverse events were observed.Interpretation - 3 years after collagenase injections for Dupuytren disease, improvement was maintained and treatment satisfaction reported in two-thirds of the treated hands, with no adverse events. Complete contracture correction was achieved in 3 of 4 MCP joints, but in only a third of the PIP joints.
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Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm; ,Department of Clinical Sciences—Orthopedics, Lund University, Lund, Sweden,Correspondence:
| | - Anna Lauritzson
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm; ,Department of Rehabilitation, Hässleholm Hospital, Hässleholm;
| | - Anna Åkesson
- Clinical Studies Sweden—Forum South, Skåne University Hospital, Lund;
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm; ,Department of Clinical Sciences—Orthopedics, Lund University, Lund, Sweden
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Zachrisson A, Sörensen AI, Strömberg J. Needle fasciotomy for Dupuytren’s contracture- a prospective cohort study of 58 fingers with a median follow-up of 6.5 years. J Plast Surg Hand Surg 2019; 54:89-93. [DOI: 10.1080/2000656x.2019.1693391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A. Zachrisson
- Department of Surgery and Orthopedics, Kungälvs sjukhus, Kungälv, Sweden
| | - A. Ibsen Sörensen
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J. Strömberg
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery and Orthopedics, Alingsås lasarett, Alingsås, Sweden
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Moog P, Buchner L, Cerny MK, Schmauss D, Megerle K, Erne H. Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:1471-1477. [PMID: 31367843 DOI: 10.1007/s00402-019-03247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The partial aponeurectomy for treatment of Dupuytren's contracture represents the gold standard for treatment of Dupuytren's contracture. In selected cases, the alternative is the percutaneous needle fasciotomy (PNF). MATERIALS AND METHODS Between 2008 and 2018, 80 rays in 64 patients were treated using PNF. 53 patients (68 rays) were reviewed with a mean follow-up of 31 months. RESULTS The recurrence rate was 18.9%. 49 patients with 62 rays had a totally free extension intra-operatively (92.4%). There were no complications. Only one patient reported a transient dysesthesia (1.8%) in the zone of operation. 86% of all patients would undergo the treatment again, if necessary. Patients were able to return to their job in an average of 5.5 days. CONCLUSIONS PNF is reliable and relatively simple to perform compared to partial aponeurectomy. Therefore, the PNF could be seen as a serious alternative for selected cases.
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Affiliation(s)
- P Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - L Buchner
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - M K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Lugano, Switzerland
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
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Molenkamp S, van Straalen RJM, Werker PMN, Broekstra DC. Imaging for Dupuytren disease: a systematic review of the literature. BMC Musculoskelet Disord 2019; 20:224. [PMID: 31101038 PMCID: PMC6525391 DOI: 10.1186/s12891-019-2606-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As treatment of Dupuytren disease (DD) is expected to shift towards prevention of progression, the use of imaging in patients with DD becomes more important. In this systematic review an overview is given of the different methods for and applications of imaging for DD that have been described. METHODS The MEDLINE and EMBASE databases were searched for articles reporting the use of imaging in patients with DD, published before May 17, 2018. Studies were systematically examined in two rounds by two observers according to the PRISMA systematic. All studies containing original data on imaging for DD were considered for inclusion. RESULTS Three hundred and seven unique studies were identified, of which 23 were included in the study. Only studies on the use of ultrasound (US) and magnetic resonance imaging (MRI) were identified. Broadly, articles could be divided into 5 categories. Seven studies were found on diagnosis, two on measurement of disease extent, four on measurement of disease activity, seven on guidance of minimally invasive procedures and five studies on evaluation of treatment. According to the Oxford CEBM, the levels of evidence were low, ranging from level 3 to 5. CONCLUSIONS A variety of applications for US and MRI for patients with DD has been described. Based on the results of this review, the largest value for imaging lies in the measurement of disease activity and the follow-up of treatment of patients with early stage disease. Unfortunately, the overall level of evidence of the available literature was low. Future research is necessary to define the exact value of US and MRI in the management of patients with DD.
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Affiliation(s)
- Sanne Molenkamp
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Roel J M van Straalen
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Paul M N Werker
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic surgery, University of Groningen, University Medical Center Groningen, BB81 Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Reply: Surgeon Volume and the Outcomes of Dupuytren's Surgery: Results from a Dutch Multicenter Study. Plast Reconstr Surg 2019; 143:1126e-1127e. [PMID: 31033846 DOI: 10.1097/prs.0000000000005546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Needle Aponeurotomy Versus Collagenase Injections for Dupuytren Disease: A Review of the Literature and Survey of Patient-Reported Satisfaction, Recurrence, and Complications After Needle Aponeurotomy. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Dupuytren's disease (DD) is a common fibrotic disorder of the hand and can significantly impair hand function. Although the exact pathogenesis of this disorder remains to be elucidated, immunological, genetic and cellular factors likely interact. In this review, we summarise recent advances in the understanding of DD pathogenesis and look to the future for potential novel therapeutic targets. In addition, we discuss the therapeutic options in DD with a focus on the need for more rigorous evidence to allow a meaningful comparison of different treatment modalities.
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Affiliation(s)
- Thomas Layton
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Abstract
Dupuytren’s disease is a fibroproliferative disease that involves collagen deposition, leading to hand contractures that ultimately affect hand mobility and grip strength. It is a benign disorder but can cause high morbidity by limiting daily activities. Many factors have been proposed for its aetiology: namely genetics, smoking, alcohol intake and diabetes. However, there is still controversy as to the main aetiological cause of the disease. Treatment is not yet uniform around the world and still varies with the surgeon’s experience and preference. In this review, the authors review the pathogenesis and treatment options for Dupuytren’s disease in an attempt to summarize the current state of the art.
Cite this article: EFORT Open Rev 2019;4:63-69. DOI: 10.1302/2058-5241.4.180021.
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Affiliation(s)
- Rita Grazina
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Sérgio Teixeira
- Serviço de Cirurgia Plástica, Reconstrutiva e Estética e Unidade de Queimados, Centro Hospitalar de São João, Portugal
| | - Renato Ramos
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Henrique Sousa
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Andreia Ferreira
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Rui Lemos
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
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Abstract
Background Percutaneous needle fasciotomy (PNF) is a minimally invasive treatment option for mild to moderate Dupuytren contractures in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and the procedure requires limited resources. Multiple contractures can be treated during the same session, and the treatment is considerably easier for the patient and requires a minimum of rehabilitation compared with limited fasciectomy1. Description PNF can be performed in a regular outpatient clinic in most cases. With the patient in a reclined position, the cord of the contracted joint is tensioned by passive extension and is divided percutaneously with a 25-gauge needle under local anesthesia. The immediate treatment effect in terms of reduction of the contracture is readily assessed, and PNF can be performed at additional levels if needed. Alternatives Collagenase Clostridium histolyticum (CCH; Xiaflex).Total or partial fasciectomy.Dermofasciectomy.Amputation (in severe cases after multiple other procedures). Rationale Local treatment with injection of CCH (Xiaflex) in the Dupuytren cord enables rupture of the cord similar to that after PNF2. Both CCH and PNF are minimally invasive treatments with obvious advantages compared with open surgery3, and they seem to have the same intermediate-term outcome4-6. However, CCH treatment is considerably more expensive than PNF and requires 2 visits by the patient to the outpatient clinic instead of 17. CCH has also been reported to have more complications than PNF2,8. Furthermore, multiple (>4) joint contractures9 can be treated by PNF at the same time. In the author's experience, even bilateral contractures can be treated at the same session if requested by the patient. As the number of patients treated with CCH and PNF has increased, there has been a corresponding decrease in more invasive procedures10; however, open surgery will probably always remain an option in more severe cases or as a secondary procedure after recurrence.
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Affiliation(s)
- Joakim Strömberg
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden
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Fletcher J, Tan ESL, Thomas M, Taylor F, Elliott D, Bindra R. Collagenase injections for Dupuytren's contracture: prospective cohort study in a public health setting. ANZ J Surg 2019; 89:573-577. [PMID: 30685881 DOI: 10.1111/ans.14988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/27/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dupuytren's disease causes a flexion contracture of the hand that limits hand function and reduces quality of life. Traditional management is surgical excision which is associated with potentially serious complications. A viable alternative is collagenase Clostridium histolyticum (CCH) (Xiaflex®; Pfizer Australia) which is an effective, safe, outpatient treatment that to date has no published data in the Australian public health setting. METHODS A prospective cohort, single centre study, enrolling 54 patients to treat 81 joints with CCH. Patients received a single dose to the cord followed by joint manipulation 48 h later. Primary endpoint was reduction in contracture to 0 to 5° of full extension assessed 4 weeks after injection. Secondary endpoints included range of motion, patient satisfaction and function as measured by the Southampton Dupuytren's Scoring Scheme (SDSS). RESULTS Primary endpoint was achieved in 48% of joints (66% metacarpophalangeal and 19% proximal interphalangeal). Mean flexion contracture improved by 40o and 25o for metacarpophalangeal and proximal interphalangeal joints, respectively. Mean active range of motion improved by 39o and 18o , respectively. At 30 days and 12 months, SDSS score demonstrated sustained improvement versus baseline (1.88 versus 8.24 P ≤ 0.0005 and 1.59 versus 8.07 P ≤ 0.0005). Sixty-eight percent of patients were either very satisfied or satisfied at 12-month follow-up. Side effects of treatment were minor; with oedema and bruising the most common (87% and 85%, respectively). CONCLUSION CCH injections are a viable treatment for Dupuytren's contracture in the Australian public health setting.
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Affiliation(s)
- Jason Fletcher
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Ezekiel S L Tan
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Thomas
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Fraser Taylor
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Devlin Elliott
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Randy Bindra
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia.,School of Medicine, Griffith University, Southport, Queensland, Australia
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